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Experts Dispute Claims of Looming Doctor Shortage

‘Team-based care’ might be the solution

Many medical groups, led by the Association of American Medical Colleges (AAMC), say there is little doubt that the U.S. is facing a serious shortage of doctors. But others, particularly health care economists, are less convinced, according to a report from Kaiser Health News.

“Concerns that the nation faces a looming physician shortage, particularly in primary care specialties, are common,” wrote an expert panel of the Institute of Medicine (IOM). “The committee did not find credible evidence to support such claims.”

Those warning of a shortage appear to have a strong case. Not only are millions of Americans gaining coverage through the Patient Protection and Affordable Care Act, but 10,000 baby boomers are becoming eligible for Medicare every day. And older people tend to have more medical needs.

In addition to a numerical shortage, there is also a mismatch between the kind of doctors the nation is producing and the kind of doctors it needs, said Dr. Andrew Bazemore, a family physician with the Robert Graham Center, an independent project of the American Academy of Family Physisians.

“We do a lot of our training in the northeastern part of our country, and it’s not surprising that the largest ratio of physicians and other providers, in general, also appears in those areas,” said Bazemore. “We have shown again and again that where you train matters an awful lot to where you practice.” That ends up resulting in an oversupply in urban centers in the Northeast and an undersupply elsewhere.

While few dispute the idea that there will be a growing need for primary care in the coming years, it is not clear whether all those primary care services have to be provided by physicians.

“There are a lot of services that can be provided by a lot of people other than primary care doctors,” said Dr. Gail Wilensky, a health economist and co-chair of the IOM panel. That includes physician assistants, nurse practitioners, and even pharmacists and social workers.

“How many physicians we ‘need’ depends entirely on how the delivery system is organized –– what we allow other health care professionals to do; [and] whether they are reimbursed in a reasonable way that will increase the interest in having people go into those professions,” Wilensky said.

Currently, physicians who are specialists make considerably more than do those who practice primary care, which many experts say is a huge deterrent to doctors becoming generalists, particularly when they have large medical school loans to pay off.

At the same time, “team-based care,” in which a physician oversees a group of health professionals, is considered by many to be not only more cost-effective, but also a way to reduce the number of doctors the nation needs to train.

“All of the efforts to the future… are to mold and morph our medical system into one that is less ‘single-combat warriors’ practicing medicine here and there, and [more] physicians and others practicing in efficient systems,” said Dr. Fitzhugh Mullan, a professor of medicine and health policy at George Washington University.

Until that happens, however, Atul Grover, chief public policy officer for the AAMC, says the nation needs to be training far more physicians.

“We don’t think we should put patients at risk by saying ‘Let’s not train enough doctors just in case everything lines up perfectly and we don’t need them,’” Grover said in a recent appearance on C-SPAN.

Wilensky is among those who find that attitude wasteful. “Are you really serious?” she says. “You’re talking about somebody who is potentially 12 to 15 years post high school, to invest in a skill set that we’re not sure we’re going to need?”

And it’s not just the individuals who could be at risk for wasteful spending. “Training another doctor isn’t cheap,” says Mullan. “It isn’t cheap for the individual doing the training; it isn’t cheap for the institution providing the education; and ultimately it isn’t cheap for the health system, because the more doctors we have, the more activity there will be.”

Princeton health economist Uwe Reinhardt points out that groups like the AAMC have a self-interest in saying there’s a shortage, to move more money towards the medical schools and hospitals they represent.

Reinhardt also says that a small shortage of physicians would probably be preferable to a surplus because it would spur innovative ways to provide care.

“My view is whatever the physician supply is, the system will adjust and cope with it,” he says. “And if it gets really tight, we will invent stuff to deal with it.”

Source: Kaiser Health News; November 24, 2014.


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